Clinical Practice Coach & Oversight, ECM, RN (Hybrid)

Position Summary/Position

The Clinical Practice Coach  & Oversight, Enhance Care Management (ECM), RN will be under the work direction of the Practice Coach Manager for ECM. ECM is a benefit program that implements interventions at the practice level to improve clinical performance, targeted outcomes to improve patient care, and implements strategies to achieve targeted transformation outcomes.

The Clinical Practice Coach  & Oversight, ECM, RN will be responsible for maintaining and monitoring transformation and strategic workflows, identifying any challenges and barriers and working with practices to facilitate redesign efforts. This position will help provide clinical guidance to the care teams, follow up on population health management and measurement base care and work towards improved processes, clinical outcomes, and value-based care.  The Clinical Practice Coach  & Oversight, ECM, RN is responsible for staying up do date with ECM Model of Care, DHCS, NCQA and HEDIS measures. 

The Clinical Practice Coach  & Oversight, ECM, RN will work in partnership with Practice Coaches to help develop any clinical workflows and training materials. Help educate ECM care teams of most appropriate decision in managing patients’ conditions and navigating the complexities of a multidisciplinary care team. The Clinical Practice Coach  & Oversight, ECM, RN may also be deployed to other partner sites based on current strategic initiatives.  

Major Functions (Duties and Responsibilities)

1. Assist ECM Providers and Care Teams with interpreting IEHP ECM Model of Care and DHCS regulatory requirements. 
2. Provide on-site and remote clinical guidance to providers, clinicians and care teams; help improve efficiency and quality by using workflow design, data tracking, reporting, and clinical data measures and transformation, with focus in:
    a. Patient and family centered care design
    b. Continuous, data driven quality improvement
    c. Sustainable business operations
    d. Pay for performance and value-based payment
    e. Preventative services 
    f. Effective utilization of the IEHP Provider portal for referrals and authorization request
    g. HEDIS performance metrics 
3. Provide clinical assistance, clinical trainings, and practice guidance to external partners: i.e., face to face meetings, bi-monthly coaching sessions, and webinars.
4. Work collaboratively with Practice Coaches, ECM Team Members, ECM Managers and Leadership to develop future material, share best practices, and work on strategies achieve best outcomes. 
5. Responsible for providing delegation oversite and conducting chart reviews. 
6. Monitor clinical documentation e.g., disenrollment, overturns for approval, approvals, and other clinical interventions for appropriateness. 
7. Provide clinical training to address chart audit findings to ECM Providers and Care Teams. 
8. Monitor and oversight ECM Care Teams and Providers to ensure adherence of clinical interventions, pathways, algorithms,  and tool kits for chronic care conditions 
9. Responsible for understanding current HEDIS and MCAS technical specifications with the ability to interpreting measures to ECM providers and care teams and developing strategies on capturing value-based metrics and quality measures. 
10. Establish and maintain a supportive role with the ECM staff, network partner management, coaching teams, assigned clinicians, care teams and their associated practices.
11. Collaborate with Provider Service Representatives (PSR) to identify providers that will benefit from additional clinical training and support, and to coordinate in partnership to deliver the identified training need. 
12. Provide feedback for opportunities to Quality Management for facility and medical record reviews, and Provider Services for any appropriate cases and concerns for further provider discussions.
13. Apply LEAN principles and concepts, (i.e., build quality, eliminate waste, optimize, increase productivity, and reduce costs) to provider performance outcomes to assist with improvement activities of the organization. 
14. Collaborate actively with Quality Management, Special Initiatives, ECM, and Provider Service Representatives Teams to review performance metrics and/or concerns of the external partners.
 

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Experience Qualifications

Five (5) years of experience in a health-related area. Operations experience in a physician’s office or hospital. Experience with quality and process improvement. Experience with Electronic Medical Records.

Preferred Experience

LEAN experience desirable. Experience with team-based care and population health management and tools preferred. Experience with complex care program design, implementation and project management.

Education Qualifications

Bachelor’s degree in Nursing or a related field from an accredited institution required.

Preferred Education

Professional Certification

Professional Licenses

Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California Board of Registered Nursing required.

Drivers License Required

Knowledge Requirement

Knowledge and understanding of Medi-Cal population. Knowledge of clinical concepts related to process and quality improvement in healthcare. Knowledge of clinical workflow development and/or redesign. Working knowledge of HEDIS and CAHPs. Knowledge of PCMH standards and recognition programs preferred.

Skills Requirement

Strong clinical knowledge, project management, communication and relationship management skills that can be used in a fluid program environment. Able to implement PDSA or like quality improvement methodologies using a data driven method. Highly organized and able to handle multiple priorities. Excellent oral and written communication skills. Excellent interpersonal skills, diplomacy, coaching and change management skills. Good Microsoft application skills (Word, Excel, and PowerPoint). 

Abilities Requirement

Ability to work independently. Ability to lead a care team to function successfully. Ability to present to large audiences. Ability to work in an office environment with the flexibility to work remotely, potential travel throughout two counties. Able to manage the stress of meeting multiple deadlines and prioritizing work activities. Ability to work with multicultural communities in a culturally competent manner.

Commitment to Team Culture

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.
Position is eligible for Hybrid work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.
 

Work Model Location

Physical Requirements